What do people often ask about joint soreness?

Sources

1. A meta-analysis of seven studies (419 patients) of preoperative high-intensity strength training before total knee arthroplasty found statistically significant post-operative improvements versus control in the 6-minute walk test (pooled SMD 0.73, 95% CI 0.04 to 1.41), range-of-motion flexion (0.40, 95% CI 0.08 to 0.72), SF-36 (1.54, 95% CI 0.32 to 2.75) and WOMAC (-0.78, 95% CI -1.22 to -0.34).

   Huang ST, Yang SW. — Preoperative High-Intensity Strength Training and Outcomes After Total Knee Arthroplasty: A Systematic Review and Meta-analysis.. Sports Health, 2026. DOI: 10.1177/19417381251388638.

2. A systematic review and meta-analysis of 120 randomised trials (10,253 participants) covering resistance training across the knee osteoarthritis continuum - 88 trials in early OA, 13 preoperative, 19 after knee replacement - found improvements in mobility, walking capacity and knee extension strength in early OA (SMD 0.46-0.81, moderate-to-high GRADE), in preoperative knee extension strength (SMD 0.47, high GRADE) and in mobility after knee replacement (SMD 0.58). Resistance training improved pain, symptoms, function and quality of life in early OA but showed NO significant effect on those outcomes preoperatively, with no increased risk versus controls at any stage.

   Brown RCC, Mora-Traverso M, Fernández-González M, et al. — Efficacy and safety of resistance training for knee osteoarthritis and subsequent knee replacement: A systematic review and meta-analysis.. Annals of Physical and Rehabilitation Medicine, 2026. DOI: 10.1016/j.rehab.2026.102122.

3. The 2023 ACR/AAHKS timing guideline conditionally recommends AGAINST delaying hip or knee arthroplasty to pursue additional non-operative treatment - physical therapy, NSAIDs, ambulatory aids or intra-articular injections - in patients with moderate-to-severe osteoarthritis for whom non-operative therapy has already been ineffective and who have chosen surgery. It conditionally recommends delay for nicotine cessation and for better glycemic control in diabetes, states that obesity by itself is not a reason for delay while weight loss should be strongly encouraged, and conditionally recommends against delay in patients with severe deformity or bone loss. Evidence for all recommendations was graded low or very low quality.

   Hannon CP, Goodman SM, Austin MS, et al. — 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective.. Arthritis & Rheumatology, 2023. DOI: 10.1002/art.42630.

4. A systematic review and meta-analysis of 89,996 patients (60.6% female, mean age 67.4) awaiting primary elective total hip or knee replacement found a significant deterioration in joint function (mean difference 0.0575% per additional day of waiting, 95% CI 0.0064 to 0.1086, p=0.028) and in health-related quality of life per additional day of waiting. Meta-analysis could not detect a relationship with post-operative outcomes, and patient responses to delayed surgery were unanimously negative.

   Cooper GM, Bayram JM, Clement ND. — The functional and psychological impact of delayed hip and knee arthroplasty: a systematic review and meta-analysis of 89,996 patients.. Scientific Reports, 2024. DOI: 10.1038/s41598-024-58050-6.

5. In a long-term follow-up of a randomised trial in 109 patients with symptomatic and radiographic hip osteoarthritis, adding exercise therapy to patient education raised 6-year survival of the native hip from 25% to 41% (p=0.034; HR 0.56, 95% CI 0.32 to 0.96), with median time to total hip replacement of 5.4 years versus 3.5 years. The authors describe this as an explanatory finding suggesting exercise therapy can reduce the need for hip replacement by 44%.

   Svege I, Nordsletten L, Fernandes L, et al. — Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial.. Annals of the Rheumatic Diseases, 2015. DOI: 10.1136/annrheumdis-2013-203628.

6. FDA states directly that regenerative medicine therapies - including stem cells, stromal vascular fraction, umbilical cord blood, amniotic fluid, Wharton's jelly, ortho-biologics and exosomes - have NOT been approved for the treatment of any orthopedic condition, naming osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain and shoulder pain. FDA further states that being charged for these products, or being offered them outside an FDA-overseen clinical trial, means a patient is likely being deceived and offered a product illegally, and that a product's presence on clinicaltrials.gov or a firm's FDA registration does not mean the product is legally marketed. Reported harms include blindness, tumor formation, neurological events and life-threatening bacterial infections.

   US Food and Drug Administration, Center for Biologics Evaluation and Research — Important Patient and Consumer Information About Regenerative Medicine Therapies. FDA.gov, 2021.